NOOTAN COLLEGE OF NURSING, VISNAGAR

SUBJECT: medical surgical nursing.

TOPIC: A seminar on pneumonia.

SUBMITTED TO: SUBMITTED BY:

Mrs.daxaben Patel ms khushbu Patel

Associate professor 1 year m.sc (n) student

st

Nootan College of nursing Nootan college of nursing

Visnagar. visnagar .
 CONGESTIVE HEART FAILURE

INTRODUCTION:
Congestive heart failure occur when your heart muscles does not pump blood as well as it should. certain
condition such as narrow artery in your heart or high blood pressure, gradually leave your heart too wear
or stiff to fill and pump efficiently.

DEFINATION:
Congestive heart failure is a clinical syndrome resulting from structural or functional cardiac disorders
that impaired the ability of the ventricles to fill or eject blood.

Heart failure is recognized as a clinical syndrome characterized by sign and symptoms of fluid overload or
inadequate tissue perfusion.

Fluid overload and decreased tissue perfusion result when the heart cannot generates cardiac output
sufficient to meet the body’s demand for oxygen and nutrients.
CAUSES OF HEART FAILURE:

A) Acute causes:

 Myocardial infraction
 Dysrrthmias
 Pulmonary embolism
 Thyrotoxins
 Hypertensive crisis
 Rupture of papillary muscles eg. Mitral valve
 Ventricular sepal defect.
 Mayocarditis.

B) CHRONIC CAUSES:

 hypertension
 RHD
 congenital heart disease
 cor pulmonale
 cardimyopathy
 trauma
 bacterial endocarditic
 valvular disorder.

PATHOPHYSIOLOGY OF HEART FAILURE:

Myocardial dysfunction

 Ischemic heart disease

 Hypothyroidism
 Mayocardial infaraction
 Valve diasease
 Alcohol,cocaine abuse
 Hypertention

Decresed cardiac output

Decresed systematic blood pressure
 Perfusion to kidney Activation of baroreceptors
 Left ventricles
 Aortic arch
 Caroid sinus

Stimulation of vasomotor regulatory center in medulla

Activation of sympathetic nervous system

Increased catecholamine epinephrine and norepineprine

Vasoconstriction

 Increased heart rate

 Increased After load
 Increased blood pressure

TYPES OF HEART FAILURE:

Two major types of heart failure identify in assessment.

1. LEFT SIDED HEART FAILURE:

 Pulmonary congestion occurs when the left ventricles cannot effectively pump blood out of
the ventricles into the aorta and the systematic circulation.
 The increased left ventricular end-diastolic blood volume increases the left ventricular
pressure, which decreased blood flow from the left ventricles during diastole.
 The blood volume and pressure build up in the left atrium and decreased flow through the
pulmonary veins into the left atrium this can causing the pulmonary edema and impaired
gas exchange.
CLINICAL MANIFESTATION

 dyspnea
 cough
 pulmonary coracles
 low oxygen saturation level
 dyspnea or shortness of breath
 orthopnea
 Difficulty in breathing while patient is lying FLAT.
 Nocturnal dyspnea
 Fluid accumulation in dependant extremities during the day
 increased heart rate
 decreased pao2
 decreased cardiac output
 changes in mental status
 restlessness and confusion

2. RIGHT SIDED HEART FAILURE

 When the right ventricle fails, congestion in the peripheral tissue and the visceral predominates.
 This occurs because the right side of the heart cannot eject blood effectively and blood cannot
accommodate all of the blood that normally returns to its form the venous circulation.
 Increased venous pressure lead to jugular venous distention and increased capillary hydrostatics
pressure throughout the venous system.

CLINICAL MENIFESTATION
  Edema of the lower extremities
 Hepatomegaly
 Ascites
 Weight gain
 Increased heart rate
 Anorexia
 Nausea
 Abdominal pain
 weakness

ASSESSMENT AND DIAGNOSTIC FINDINGS:

Assessment of ventricular function is an essential part of the initial diagnostic workup.

ECHOCARDIOGRAM:

Echocardiogram is usually perform to determine the heart failure, identify anatomic futures such
as structural abnormalities and valve mal functions and conform the diagnosis of HF.

ELECTROCARDIOGRAM:

ECG is obtained to assist the diagnostics.

CHEST X-RAY.

LABORATORY STUDIES

It includes serum electrolytes, blood urea nitrogen, creatinine, liver function testes. Thyroid and
urine analysis.

MEDICAL MANAGEMENT:
The overall goal of management of heart failure is to delivered patient symptoms, to improve functional
status and quality of life, and to extend survival.

Specific intervention is based on the stages of heart failure.

The objectives of medical management includes following:

 Improvement of cardiac function

 Reduction of symptoms and improvement of functional status.
 Stabilizations of patient conditions and lowering of the risk of hospitalization.
 Delay of the progression of heart failure and extension of life expectancy.
 Promotion of life style conducive to cardiac health.
Angiotensin converting enzyme inhibitors

 ACE inhibitors slow the progression of HF , improve exercise tolerance and decreased the number
of hospitalization for HF.
 It promotes vasodilatation dieresis, ultimately decreasing after load and preload.

Angiotensin receptors blockers ( valsartan, losartan)

 It decreased blood pressure and decreased after load relives sign and symptoms of heart failure
improve exercise capacity.

Hydralazine and isosorbide dinitrate

 Hydralazine lower systematic vascular résistance and left ventricular after load. This combination
of medication as also recommended in heart failure.

BETA BLOCKERS:

 They relax blood vessels , lower blood pressure and decreased after load and decreased cardiac
workload.
 beta-blocker such as carvelidol and metropolol have been found to improve the functional status .

DIURETICS

 diuretics are prescribed to removes excess extracellular fluid by increasing the rate of urine
produced in patient with sign and symptoms of fluid overload. Loop thiazid and aldosterone
blocking diuretics may be prescribed for the patient with HF.

DIGITALIS ( DIGOXINE)

 Digoxine increased the force of mayocardial contraction and slow conduction through
atrioventricular nodes. it improve cardiac contractility , decreased sigh and symptoms of heart
failure.

Intravenous infusion:
 IV nitrotropes: increased the force of myocardial contraction as such as they may be indicated for
hospitalized patient with acute decompensate heart failure.
 These agent are used for patients who do not responds to routine pharmacological therapy.
 Dobutamine: it is another IV medication administered to patient with significant left ventricular
dysfunction and hyper perfusion. Its major action is to increased cardiac contractility and renal
perfusion to enhance urine output.
 It is also increased heart rate and can precipitate ectopic beats and tachydysrhythmias.
NUTRITIONAL THERAPY:

 Following low sodium diet and avoiding excessive fluid intake are usually recommended.
 Decreasing dietary sodium reduce fluid retention and the symptoms of peripheral and pulmonary
congestions.

NURSING MANAGEMENT:
NURSING DIAGNOSIS:

 activity intolerance rebated to the decreased co

 Excessive fluid volume related to the heart failure.
 anxiety related to complexity of the therapeutic regimen
 Powerlessness related to chronic illness and hospitalization.
 Ineffective family therapeutic regimen management.

Collaborative problems:

potential complication may associated included:

 Hypotention, poor perfusion, cardiogenic shock.

 Dysrhythmias
 Thromboembolism
 Pericardial effusion and cardiac temponade.

PLANNING ANG GOAL:

Major goal for the patient may includes promoting activity, reduce anxiety, revive fluid overload
symptoms, decreasing anxiety or encouraging the patient to verbalize his or her ability to make decision
and influence outcomes, and educating the patient and family about management pf the therapeutic
regimen.

NURSING INTERVENTION:

PROMOTING ACTIVITY TOLERANCE:

 Reducing the physical activity caused by heart failure symptoms leads to physical reconditioning.
 Prolonged activity which may be self imposed should be avoided.
 Provide temporary bed rest if hospitalized or advice the some types of physical activity every day.
 The patient should increase the duration of activity then the frequency, before increasing the
intensity of the activity.

MANAGING FLUID VOLUME:

  Patient with severe heart failure my receive IV diuretics therapy: how ever patient with less severe
symptoms are typically prescribed oral diuretics.
 A patients’ fluid status is monitored closely by auscultation the lungs, monitoring the daily body
weight and assisting the patient to adhere low sodium diet by reading food labels and avoiding
high sodium food.

CONTROLLING ANXIETY:

 Nurse take steps to promote physical comfort provide psychological support.

 Oxygen may be administered during an acute event to diminish the work of breathing and increase
the patient comfort.
 A nurse can educate the patient and families about technique for controlling anxiety and avoiding
anxiety provoking situations.

MINIMIZE POWELESSNESS:

 Nurse should help patient to recognize their choices, and that they can positively influences the
outcome of their diagnosis and treatment.
 Taking time to listen actively to patient encourages them to express their concern and ask
questions. other strategies to provide opportunity such as when activities are to occur or
encouraging food and fluid choices consistence with the dietary restriction.

HEALTH EDUCATION
 The nurse provides patients health education and involves the patients and families in the
therapeutic regimen to promote understanding and adherence to plan.
 When the patient recognize that diagnosis of HF can be successfully managed with life style
changes and medications, recurrences of acute HF lessons, unnecessary hospitalization decreased
and the life expectance increased.
 Nurses teach the patient and family about diet, medication management, stop alcohol
consumption, activity, exercise recommended.
 Summery
At the end of the seminar class will able to understood about the introduction of heart failure, definition
of heart failure, causes of heart failure, path physiology of heart failure, different types of heart failure,
clinical manifestation of heart failure., medical or nursing, management of heart failure.